Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
Int J Surg. 2019 Dec;72:198-203. doi: 10.1016/j.ijsu.2019.11.008. Epub 2019 Nov 18.
Several sphincter saving techniques have been described for complex anal fistula (CAF) with variable outcomes. The present trial aimed to compare two techniques for CAF; the drained mucosal flap technique and rerouting Seton around the internal anal sphincter (IAS).
Adult patients with high trans-sphincteric anal fistula were randomly assigned to one of two groups: group I underwent mucosal advancement flap with drainage Seton rerouted around the external anal sphincter, and group II underwent rerouting Seton around the IAS. The two groups were compared in terms of the incidence of postoperative fecal incontinence (FI), healing of fistula, complications, and changes in anal pressures.
97 patients (80 male) of a mean age of 39.5 years were included. One patient developed FI in group I versus 7 in group II (p = 0.03). Failure of healing occurred in 2 patients in group I and 4 in group II (p = 0.43). In group II, the average time for spontaneous fall of Seton was 14 ± 2.8 days whereas in group I the average time for removal of Seton was 40 ± 14.9 days (p < 0.0001). There were no significant differences between the two groups in complication rate. Postoperatively, the decrease in resting anal pressure was significant in Group II but not group I.
The drained mucosal flap technique was associated with significantly lower incidence of FI, yet longer operative time and longer time to complete healing compared to rerouting Seton around the IAS. The success rates of both techniques was comparable.
已经有几种保留括约肌的技术被用于治疗复杂的肛痿（CAF），但效果不一。本试验旨在比较两种治疗 CAF 的技术：黏膜推进瓣技术和经括约肌间瘘管结扎术（Seton）。
将患有高经括约肌 CAF 的成年患者随机分为两组：组 I 行黏膜推进瓣加引流 Seton 经外括约肌环扎，组 II 行括约肌间 Seton 环扎。比较两组术后粪便失禁（FI）、瘘管愈合、并发症和肛门压力变化的发生率。
97 例（80 例男性）患者的平均年龄为 39.5 岁。组 I 中有 1 例发生 FI，组 II 中有 7 例（p=0.03）。组 I 有 2 例愈合失败，组 II 有 4 例（p=0.43）。组 II 中 Seton 自然脱落的平均时间为 14±2.8 天，组 I 中 Seton 去除的平均时间为 40±14.9 天（p<0.0001）。两组的并发症发生率无显著差异。术后，组 II 的静息肛门压力下降显著，但组 I 无此变化。
与经括约肌间 Seton 环扎术相比，引流黏膜瓣技术 FI 发生率显著降低，但手术时间较长，完全愈合时间较长。两种技术的成功率相当。
